Time allowed for medication administration changing.

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An e-mail went out today from the Pharmacy head stating that a (hospital) corporate wide change went into effect today. Until today, a medication could be given up to 1 hour before or as much as 1 hour after the scheduled time without it being considered early or late. A 0900 medication could be given as early as 0800, or as late as 0959. Starting today, that 1 hour window was narrowed to 30 minutes. A 0900 medication could be given as early as 0830 or as late as 0929.

Now, take it for granted that as nurses we all want to give a 0900 dose at 0900.

This just got me to wondering...What kind of policies are out there? For how many patients are those nurses providing care? How many/what kinds of meds and accuities? Do the policies work?

[FONT=Arial Narrow]We use computer barcode medication administraion (BCMA) This covers the 1hr 59" period.
[FONT=Arial Narrow]If you're early or trying to give the med later, it automatically asks for an explanation.
[FONT=Arial Narrow]The joy of BCMA is, that IF it works correctly, you CAN'T make a med error.

I was also taught the 30 minute rule. Then when I moved to the unit where I currently work; I was taught 1hr. Of course I have my own opinions like once a day meds just don't matter if they are off by a few hours. Of course most of the meds I give in my current environment are baby meds like antibiotics, iron, caffeine. Antibiotics and pretty much all IV meds should be given very close to when they are due, but seriously; I'm not writing myself up for giving some kid their iron or caffeine a couple of hours late.

I also consider that often the MD's will order a med as BID or TID and pharmacy will print the MAR as q12hr or q8hrs. So I don't feel bad not sticking to the original order rather than the schedule pharmacy chooses.

Here in Iowa, I was taught one hour before and one hour after also. 30 minutes would be pretty tough in a nursing home setting with 35-40 residents during a med pass....plus accu checks and insulin injections.

30 minutes before or after here too. As far as BID/TID. Different hospitals will set them differently. Ex. one hospital may use 0900 for QD, 0900 and 1700 for BID, and 0900, 1300, and 1700 for TID. QID 0900, 1300, 1700, & 2100. Ours uses hours 1 hr later than these.

If a doc orders BID, Pharm will automatically use the standard BID times. It's up to the nurse to change it if times should be different. Ex: doc orders NPH insulin BID. It appears on MAR as 1000 and 1800. The nurse must change to 0800 (before breakfast) and 2200 (bedtime). Same thing if med should be given q12hrs and doc orders BID.

it depends on the census. if you have a high census and are unable to give the meds 30 min before/after...maybe they need to reconsider staffing. if you start gettin written up for it, i'd be calling the supervisor to let her know if it wasnt going to be possible. at least then you could cover yourself. it figures a pharmacist would make these kinds of decisions without considering the reality of a situation.

30 minutes before or after here too. As far as BID/TID. Different hospitals will set them differently. Ex. one hospital may use 0900 for QD, 0900 and 1700 for BID, and 0900, 1300, and 1700 for TID. QID 0900, 1300, 1700, & 2100. Ours uses hours 1 hr later than these.

If a doc orders BID, Pharm will automatically use the standard BID times. It's up to the nurse to change it if times should be different. Ex: doc orders NPH insulin BID. It appears on MAR as 1000 and 1800. The nurse must change to 0800 (before breakfast) and 2200 (bedtime). Same thing if med should be given q12hrs and doc orders BID.

you can change the times IF you want to be cited for practicing medicine without a license....if the institution has a prescribed time for BID, that is what you need to use....what you need to do is call the doc and get it ordered for appropriate times......i am sure in hospital, you do this all the time....but i dont think this will go over well with jacho (sp)

I don't see changing the times as practicing medicine without a license. Changing the frequency would be an order change, but what times? Unless the doc writes for a specific time, and there are few who do, we time the meds for when it is reasonable and appropriate to give them.

Example: admission arrives at 0100 with orders for some BID meds. Now the patient is awake, no problem. I will consider what those meds are that possibly he missed the evening dose, before giving them, because we're about 6-7 hours away from the morning dose. There are things that although they might be BID, I don't want to give that closely together. And I don't control admission times so I am not responsible for the fact that he was ordered meds at 2100 in the admit orders and arrived on my floor well after midnight. This is just an example mind you.

The admits always do give me problems. If they arrive dinnertime or later, whether or not they got their meds that day, I am not going to attempt to give a whole day's meds just in the evening/overnight. With my patients it just sets them up for low heart rates, bottomed out blood pressures, etc. either in the middle of the night or the next AM after the normal dose is given around 0800/0900. So, no thanks.

And what about those "Q 6 hour" and "Q 8 hour" dosed meds? eh? So if your patient's lopressor is due and you hold it for a heart rate of 44, would you give it the next time he's up and about with a decent heart rate, or wait 6-8 hours until it's due again and then check HR/BP to see if you can give it? The docs I work with didn't sit down and write exactly what time we had to give the meds, and it exasperates the cardiologists if a nurse holds the meds all the time because they only check the VS when it says the meds are due on a sheet of paper... I really hope you don't call that bit of nursing judgement and time management, practicing medicine without a license. Good grief. If that's what it is, omygosh, better call the state board 'cause we're all in trouble!

Edit: Ok I found the flaw in your statement. "If the institution has a prescribed time" is the flaw. The institution does not "prescribe" medications, the doctor does. The pharmacy prints times that they think are reasonable for administration based on mealtimes and when people are likely to be awake. That has absolutely ZIP to do with the act of prescribing a drug. Adjusting what time to give a med is well within the boundaries of nursing practice.